1 2
Notes on Bipolar Disorder1
Mind
Picture
Memory
DEPRESSION
e iv t ga Ne Pa st ert trov In
i n f o rm
ation
rgy No ene o t Nothing r e t f go a
Mind S L O W
Blank
to Energy r f te a e s cha l a o g th e
e v i sit re Po utu ere F th t u O
inform ation
i
can’t assimilate information to give memory
4 Essential + 1 or more symptoms for more than 2 weeks = DEPRESSION F Feeling – feel depressed, flat, empty Essential E Energy – low, fatigue symptoms S Sleep – oversleep, broken sleep T Thinking – slow, speak slow, move slow, poor concentration I Interest – lose interest e.g. work, personal relationship, sex, religion, sport V Value – low self esteem, not worthwhile, wicked, hopeless, delusions e.g. bankrupt, cancer A Aches – physical illness (because of tension in muscle) e.g. headache, tightness in chest, back pain, injury L Live – not want to live ELATION symptoms are the opposite. Difficult to get to sleep, or wake up early. 1
Dr. Patrick McKeon presents Bipolar Disorder, http://www.youtube.com/watch?v=fHGTuqiaAYw 1
SEVERE
Non acquaintance can see that, hospitalization
ELATION
MODERATE Close friends can spot out
MILD
Only those live with him/her can spot out
MILD
Tired, poor concentration, lack of competence
DEPRESSION MODERATE Tired, poor concentration, lack of competence
SEVERE
Quite disabled, more likely to have psychotic e.g. I have cancer, I am wicked, risk of suicide, hospitalization
E
E
When the person is with elation, it’s often a pleasure experience, but he may suddenly feels distressed, agitated, weeps and feels awful without external cause. He couldn’t see he’s in elation. When he gets to the depression stage and slows down, go back to spot out where the elation came from, then deal with the depression. The person may say he feels depressed, anxious, or frightened in a paranoid way, but he behaves different from a depressed person. He looks agitated, irritable, wounded up, restless, driven, and trouble to get to sleep at night, eye is darking. à not like unipolar depression “ Mixed mood stage/non-‐pleasant high/dysphoric hypomania/ agitated depression.” à Bipolar à do not use antidepressant, or it boost the elation Unipolar depression
D
Causation
Average
70% genetics
30% environment
Some people are triggered by seasonal mood disorder/change in night shift 10% 90% Some people are triggered by major trauma e.g. death, accident, increase work 10% 90%
2
Relationship
Depression – attack/avoid relationship R Elation – intrude others
R
B P
Emotional jelly bean
BP
Medication – most effective, essential, put on medication before other intervention like CBT, mindfulness
Bipolar I – big high (hospitalization/big interruption on the person’s life) followed by depression Most effective, safest and prevent next outbreak -‐ Lithium
E D
Unipolar mania (speed up, cf. depression = slow down) 20-‐30% Lithium alone is effective 70-‐80% Lithium + antipsychotic mood stabilizers e.g. Risperidone Hypomania
E
Intervals become shorter Teens 20’s late 20s 30’s
small high 40’s
more mark high
More frequent cycle of mood
We have to switch the hypomania off. If treat with determines the next low. Switch it off to antidepressant stop the cyclic mood. Lithium is not effective. Mood stabilizers more effective e.g. Lamotrigine ★For patients with recurring unipolar depression and with a BP family history, avoid use of antidepressant, or if you must use it, only use in brief period.
3
General maintenance 1. Know the illness, gather information, take ownership, show the lead, don’t turn away from it, face it 2. Acknowledge, do not deny or keep the family outside, “don’t check up on me” 3. Let family in, do not blame outward/inward 4. Family need group support 5. Management – support family/team to spot early clues. Be a team manager to invite family/ friends, preferably those live in the same house, and to give permission when you are in a well stage e.g. when they detect mood change to elation to take action like to take away your credit card, to take you to the doctor, to get you to treatment etc. Spotting phase, spot mood changes, spot relapse, spot depression(easy because it’s painful) , more difficult to spot elation because the high mind would rationalize why he couldn’t sleep e.g. because of coffee etc . Spotting relapse by his behavioral change e.g. change in clothing. 6. After the period of relapse, it’s important to allow those you may hurt during the relapse to let out their hurt feelings, to be responsible to face them, so they may remain support rather than walk away 7. No alcohol 8. Record of mood 9. Regularity of life
Circadian Rhythm
Blue light
eye
control Suprachiasmatic regulate Rhythm of body Nucleus clocks in brain 80% (a big clock) lung, heart, gut
Blue light control the Suprachiasmatic Nucleus (a big clock) that in turn regulate an orchestra of clocks in the brain, lung, heart and gut/the rhythm of the body. Seasonal pattern: mania in summer, depression in winter. Get to bed on time at night, get out of bed 8 hours later, no matter what, and try not nap in day. Wind down an hour before going to bed. Bright light from phone, TV, ipad, monitor could over-‐ stimulate retina/brain. The BP brains are more sensitive to light change, coffee. Meal at fixed time. Social contact, amount of food and regular exercise are also important. These influence concentration, enthusiasm, energy and mood.
4